Can I use my Health Insurance?


What your insurance covers for mental health services:

One of the most challenging pieces of beginning the journey of counseling is navigating the insurance maze.  Too often it is not clear on what one’s benefits cover Even knowing the definition of insurance terms can be a challenge. Let’s tackle this process to keep any road block clear from a client getting the help they need.

Some of the most common words that come up in the insurance world are below.  These definitions cover the amount of payment the client will be responsible for covering as well as who they can see for treatment.

  • Deductible – the expense that must be paid out of pocket before an insurer will pay any expenses.
  • Copayments –  a fixed payment for a covered service, paid when an individual receives service.
  • Coinsurance – refers to money that an individual is required to pay for services after a deductible has been paid.
  • In network providers – refers to providers or health care facilities that are part of a health plan’s network of providers with which it has negotiated a discount. Insured individuals usually pay less when using an in-network provider.
  • Out-of-network provider –  is one which has not contracted with your insurance company for reimbursement at a negotiated rate. Some health plans do not reimburse out-of-network providers at all, which means that as the patient, you would be responsible for the full amount charged by your doctor.
  • Private Pay –   a client is responsible to pay for the treatment out of their own pocket without going through their insurance.
  • EAP – An employee assistance program (EAP) is a work-based intervention program designed to identify and assist employees in resolving personal problems. Examples of issues that are covered by an EAP program are marital, financial or emotional problems; family issues; substance/alcohol abuse. To be covered by an EAP program these issues would have to be interfering with job performance.

Insurance also comes from a variety of avenues.  One of the most common is through an employer. For a company to be required to provide insurance they must have 50 or more employees.  It is not required to provided insurance for part time employees.  That is the choice of the company.  Another form of coverage is purchased through health insurance exchanges that were created under the Affordable Care Act, better known as Obama Care.  This form of insurance is be evaluated and most likely replaced by the President Trump administration.

In cases in which purchased, health care is not financially possible there are two options.

Children’s Health Insurance Program (CHIP) is medical coverage source for individuals under age 19 whose parents earn too much income to qualify for Medicaid, but not enough to pay for private coverage. … Some states also cover parents and pregnant women.

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